Peculiar angiographic predictors of impending left ventricular rupture after primary coronary angioplasty.
BACKGROUND
Peculiar angiographic characteristics predictive of impending left ventricular rupture have not yet been described in primary percutaneous coronary angioplasty era. Our study is aimed to evaluate the existence of peculiar angiographic determinants of impending left ventricular rupture after primary percutaneous coronary angioplasty.


METHODS
We retrospectively analyzed medical and angiographic records of patients referred to our center for acute myocardial infarction (AMI) and submitted to primary angioplasty between 1st May 2005 and 30th September 2007. All the coronary angiograms and coronary angioplasties were reviewed by two independent observers blinded to the final outcome of the patients searching for any abnormal angiographic signs of impending left ventricular rupture.


RESULTS
The records of 348 patients (mean age, 76+/-25.8 years, 198 females) with AMI submitted to primary percutaneous coronary interventions (PCI) have been reviewed and analyzed. Left ventricular rupture occurred in 11 patients (3.16%): 10 of 11 patients died, whereas one survived to an inferoposterior left ventricular rupture conservatively managed with repeated pericardiocentesis and blood transfusions. The observers found in all 10/11 cases (2.87%) of left ventricular ruptures some angiographic signs of impending rupture such as round-shaped contrast persistence in the region of the rupture confirmed by autopsy or in the only one survivor by computed tomography. No similar images were detected on angiography of the remaining 337 patients (P<.001). Logistic regression analysis demonstrated that only long time that elapsed from symptoms onset, cardiogenic shock, and abnormal angiographic contrast dye persistence images were independent predictors of cardiac rupture.


CONCLUSIONS
Angiographic signs of impending ventricular rupture can be observed during primary coronary angioplasty and could help physicians to adopt a more accurate echocardiographic protocol in patients with such signs in order to refer patients without delay to surgical repair.
Rigatelli
Gianluca
G
Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
Cardaioli
Paolo
P
Dell'Avvocata
Fabio
F
Giordan
Massimo
M
Roncon
Loris
L
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001803:Blood Transfusion; D017023:Coronary Angiography; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D020519:Pericardiocentesis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000150:complications; D013997:Time Factors; D014057:Tomography, X-Ray Computed